Most modern hearing aid wearers use Behind the Ear hearing aids. They're easy to fix, quick to clean, and fit even the highest degrees of hearing loss. Every Big 7 brand has BTE hearing aids, most smaller brands have BTE hearing aids, and even the majority of Personal Sound Amplifiers use microphone consoles similar to BTE hearing aids.
Because BTE hearing aids are easy to assemble, they are easy to fit with the latest and greatest technologies. Many BTEs are rechargeable, and most BTEs today have either full Bluetooth connectivity or NFMI, which allows the unit to be controlled by a remote smartphone app. BTEs are often the cheapest AND the most expensive type of hearing device depending on technology.
Overwhelmed yet? Don't be. Most BTEs are one of two categories:
RITE hearing aids:
The majority of the adult hearing aid market today is in a RITE style hearing aid, also known as RICs (Receiver-in-canal) or SIEs (Speaker-in-ear). They are smaller than traditional BTEs. RITEs have a small wire that connect the console to a speaker, which sits inside the ear canal. Usually a small silicone dome holds the speaker in place. Because the speaker is on the end of the wire, RITEs are usually small. The battery, or rechargeable power cell, and digital signal processing chip are in the console. RITEs can have molds that either click onto the receiver wire, or are built into it.
Traditional BTE hearing aids:
Traditional BTEs are primarily aimed at the pediatric market because it's easier for growing children to repurchase acrylic earmolds than to buy new hearing aid during every growth spurt. BTEs are designed to fit the highest severities of hearing losses in adults, or specific circumstances (more on that in a moment...). Traditional BTEs usually have a custom-cut acoustic tube and mold attached to the BTE console, but can also be worn "open fit", with a skinny tube and RITE-style dome. The speaker is at the top of the acoustic tube, in the actual console, which forces BTEs to be slightly bigger. The speaker, microphone, and digital signal processing chip are all in that console. Tight fit!
When would an adult fit a BTE over an RITE?
RITEs are clearly the smaller and more attractive choice. On top of that, RITEs have the least mechanical noise because the speaker and microphone are so far apart. So when would anyone prefer a traditional BTE? Believe it or not, RITE are notoriously over-fit by many MANY hearing aid dispensers in Hampton Roads and beyond. Why?
The first type of person to not fit with RITEs is someone prone to getting the speaker dirty. Are you in a RITE hearing aid that gets clogged every other month? Are you always replacing wax traps? Anyone with an overproduction of earwax is going to find a RITE to be a huge pain in the ear. The speaker is only covered by a silicone dome. If you see wax on your music earbuds when you remove them, you will see wax in your speaker when you remove your hearing instrument. People with sinus drainage in their ears or Eustachian tube dysfunction that backs up into the ears would also do better with a BTE over an RITE. This is the other common reason to fit kids in BTEs. They are most prone to certain types of ear infections and drainage. After years of fittings, trust me, you will not mind trading another centimeter of size to give up all those cleaning appointments.
The second type of person to not fit with a RITE is someone with severe low frequency loss. RITEs are comfortable because the ear is so open, but the bass sounds have a tendency to just bleed out, especially when the RITE is fit with a dome instead of a mold. If you know you have a severe low frequency loss, and you want to downsize into a RITE, enjoy calling every sound "tinny" for the next 5 years.
At the end of the day, you and your hearing care professional should consider either style of hearing device. RITEs are a fantastic choice for the majority of hearing aid wearers, but don't allow yourself to be misfit because of a size concern!